Medicare and Medicaid only cover a small portion of prescriptions

For the study, researchers looked at data from IQVIA's national prescription audit PayerTrak, a system that covers 92% of prescriptions dispensed and filled by U.S. pharmacies.

They specifically looked at prescriptions for semaglutide, the active ingredient in the anti-diabetes drugs Ozempic and Ryvelsus, and the anti-obesity drug Wegovy.

They also investigated the type of payment used for the prescriptions (private health insurance, Medicaid, Medicare Part D, or cash).

The researchers found that the number of semaglutide prescriptions increased by more than 442% (from 471,876 to 2,555,308) between January 2021 and December 2023. Of these, more than 70% were prescriptions for Ozempic.

During this period, prescribing of semaglutide increased across all payment methods, but most prescriptions were filled using private insurance, especially on Wegovy.

In 2023, private insurance accounted for 61.4% of Ozempic prescriptions, 89.5% of Wegovy prescriptions, and 58.1% of Rybersus prescriptions.

In contrast, Medicare Part D accounted for just 28.5% of Ozempic prescriptions, 32.9% of Libersus prescriptions, and 1.2% of Wegovy prescriptions.

In 2023, Medicaid covered fewer than 10% of prescriptions for these three drug brands.

Only a small number of people paid cash for Ozempic and Ryversus, each accounting for less than 1% of total prescriptions.

The proportion of cash payments made for Wegovy was even higher in 2021 at 12.7% of prescriptions, in 2022 at 2.6% and in 2023 at 1.2%.

This trend may represent an expansion of insurance coverage for this drug over time.

Robert Klitzman, MDThe professor of psychiatry and director of the master's program in bioethics at Columbia University said the new findings are important but don't tell the whole story, especially about why these prescribing trends are happening.

For example, would people with Medicare or Medicaid feel comfortable asking their doctor to prescribe weight-loss medication? How many of them stop taking the medication after a few months? And does this vary by type of insurance?

“There's room for further research to understand why there are disparities in the number of people taking these drugs among those with Medicare, Medicaid and private insurance,” Kritzman said.

But he noted that in 2022, 54.5% of Americans will have private insurance, 18.8% will be on Medicaid and 18.7% will be on Medicare. According to the U.S. Census.

“So the distribution of prescriptions is JAMA Health Forum “This article is not as surprising as it might first seem,” author Kritzman says. Doctor, Can You Pray for Me?: Healthcare, Pastoral Care, and the Healing of the Whole PersonHealthline said.

Also, the fact that Medicare patients are more likely than other patients to be taking Ozempic or Ryversus may be due to the fact that these people are older and therefore Heart disease or have had a stroke, they may be eligible to receive these medications.”

Overall, Kritzman believes the study offers just a glimpse into how well the U.S. is dealing with the obesity epidemic.

More Two in five American adults According to the Centers for Disease Control and Prevention, the percentage of adults living with obesity is higher among black adults and those with less education.

While the newer GLP-1 drugs have proven highly effective at helping people lose weight and keep it off, as long as they are taken, Kritzman believes this is only part of the solution.

“You want to get good treatment. [such as GLP-1s] “We want to make it available to everyone,” he said, “but we don't want people to think, 'If everyone takes the drug, everyone is treated.'”

Healthy eating, Physically active Learning how to deal with stress can also help you lose weight, among other benefits.

“Exercise not only helps you lose weight, it also benefits your cognitive functioning and heart health,” Kritzman says.

but, Lydia C. Alexander, MDThe president of the Obesity Medicine Society and chief medical officer of Enara Health warns that the idea that people should be able to lose weight through diet and exercise alone, without the use of GLP-1 drugs, reinforces the stigma surrounding obesity.

people obesity sometimes It was judged Because “I don't take care of my health” or “I don't try as hard as I can” Maintain a healthy weight” she told Healthline.

“This mindset is very common even among primary care physicians,” she added.

While nutrition, exercise and lifestyle changes are essential in treating obesity, “obesity is a disease,” Alexander said, “and like any disease, medications may also be needed.”

“Obesity is a metabolic dysfunction in which the body doesn't receive the right signals to maintain a healthy weight,” she says.

One limitation of the new study is that the researchers did not have information on why people were prescribed semaglutide, which may have influenced prescription rates.

Ozempic initially Type 2 diabetesand later, reducing the risk of serious heart disease in adults with cardiovascular disease who are overweight or obese.

This medicine sometimes Off-label prescription To help lose weight, which was especially common before Wegovy was approved by the U.S. Food and Drug Administration in June 2021 as an anti-obesity drug.

Coverage for semaglutide and other GLP-1 medications will vary depending on the type of health insurance you have and the medical condition they are prescribed to treat.

“Medicare Part D covers GLP-1 drugs used to treat type 2 diabetes and for people with cardiovascular disease who need to lose weight,” Alexander said.

But “there is actually a provision that prohibits the treatment of obesity.” [alone] “As part of Medicare,” she said, “GLP-1 is not readily available to Medicare recipients for any use.”

Because Medicaid is a state-run program, GLP-1 coverage varies by state.

“For example, in Arizona, it's relatively difficult to get obesity medications covered by Medicaid,” Alexander said, “but in California, these drugs are included in Medicaid coverage and often don't require prior authorization.”

Commercial insurance plans vary in what they cover.

but, Recent investigation One-third of employer-sponsored health plans reported covering GLP-1 drugs for both diabetes and hypertension.and weight loss. That's up from about a quarter in 2023.

Moreover, a report by the International Employees' Benefits Fund found that more than half of employer health plans cover GLP-1 drugs only as treatments for type 2 diabetes.

However, among employers who cover GLP-1 for diabetes only, nearly one-fifth said they would consider offering the drug for weight loss.

your Health Insurance Plans Check your plan's formulary and summary of benefits and coverage (SBC) to see if your insurance covers GLP-1 for weight loss. This information should be available on your insurance company's website.

Ro, which provides medical care directly to patients, also recently GLP-1 Insurance Coverage Checkeris a free tool that can help you find out if your insurance will cover treatment with a GLP-1 drug.

The company News Release Nearly half of patients had coverage for a GLP-1 for weight loss, and most patients had coverage for multiple medications.

Moreover, the company says that about two-thirds of its insured patients pay less than $100 per month, but most companies require patients to get prior authorization before they can get the drug.

of List price A month's supply of Wegobee costs about $1,350, before discounts or rebates for the uninsured. Drugmaker Novo Nordisk also offers a discount card that allows users to buy a month's supply of the drug for $650 in cash.

The researchers found that private health insurance paid for the majority of prescriptions for the diabetes drugs Ozempic and Ryversus, and the obesity drug Wegovy, in the United States from 2021 to 2023. This trend was particularly pronounced for Wegovy.

The low number of people who paid for prescription drugs through Medicare or Medicaid may reflect the fact that fewer Americans have these health insurance plans, but Medicare does not cover Wegovy, and Medicaid coverage of GLP-1 drugs varies by state.

The study offers a glimpse into how well the country is tackling the obesity epidemic, but experts say more information is needed — for example, why prescription rates vary across plans, and how many people are being prescribed these drugs just to lose weight.